Disease Activity Score Of 28 Joints - Erythrocyte Sedimentation Rate Research Articles

Diagnostic and Predictive Utility of Serum Interleukin-37 in Rheumatoid Arthritis: A Case-Control Study

Background: Rheumatoid arthritis is the most common cause of inflammatory polyarthritis. Interleukin‐37 (IL-37) has been found to play an important regulatory role in the development of inflammatory diseases. Objectives: To assess serum IL-37 level in rheumatoid arthritis (RA) patients compared to controls, to evaluate its diagnostic and predictive utility in RA patients and to investigate IL-37 level correlation with demographic and clinical characteristics of RA. Methods: Eighty subjects, 40 RA patients aged between 23-63 years and 40 healthy controls aged between 28-67 years were evaluated. An enzyme-linked immunosorbent assay (ELISA) was used to analyze the serum IL-37 levels. Results: Serum IL-37 was significantly higher in RA patients compared to healthy controls. At optimum cut off value of >58.275 pg/ml, serum IL-37 had 100% accuracy, positive predictive value, negative predictive value, sensitivity, and specificity. Serum IL‐37 level was not significantly related to Disease Activity Score of 28 joints‐erythrocyte sedimentation rate (DAS28‐ESR), also not correlated with C-reactive protein(CRP), rheumatoid factor(RF) and anti-cyclic citrullinated peptide antibody (Anti-CCP). Also there was no correlation between the level of IL-37 and treatment. Conclusions: IL-37 was significantly higher in RA patients compared to healthy controls with a high diagnostic and predictive ability, and may be a potential biomarker for diagnosis and prediction of RA.

Relationships of the stand-up time to falls and fractures in patients with rheumatoid arthritis: Results from the CHIKARA study.

Patients with rheumatoid arthritis (RA) have a higher risk of falls and fractures due to muscle weakness and painful joints of the lower extremities. Evaluation of muscle functions is important to predict falls and fractures. The aim was to investigate the relationships of muscle functions with falls and fractures in RA patients. Stand-up muscle power, speed, and stabilizing time were evaluated by a muscle function analyzer in 90 RA patients in the CHIKARA study (UMIN000023744). The relationships of the muscle functions with falls, fractures, body composition, Disease Activity Score of 28 joints - erythrocyte sedimentation rate (DAS28-ESR), modified Health Assessment Questionnaire (mHAQ) scores, Steinbrocker class, stage, sarcopenia, and frailty were investigated in a cross-sectional study. Each parameter of muscle function was related to age, falls, frailty, and the leg muscle score. However, only stabilizing time was related with fractures (r=.217, P=.04). When stabilizing time was≥1.13 and ≥1.36seconds, the odds ratios for falls and fractures were increased 6.2-fold compared to<1.13seconds (95% CI: 1.2-20.1, P=.002) and 11.4-fold compared to <1.36seconds (95% CI: 1.7-92.5, P=.071), respectively. Sarcopenia and skeletal muscle mass were not significantly related to each muscle function. There was a negative correlation between DAS28-ESR and power. Steinbrocker class and mHAQ had negative correlations with power and speed. Sarcopenia and skeletal muscle mass were not adequate indicators of muscle functions in RA patients. Analyzing muscle functions is helpful to predict falls and fractures. Patients with extended stabilizing times should recognize the increased risk of falls and fractures.

Effects of dehydroepiandrosterone on quality of life in premenopausal women with rheumatoid arthritis: A preliminary randomized clinical trial.

Chronic inflammation and subsequent use of glucocorticoids can lead to relative adrenocortical insufficiency in patients with rheumatoid arthritis (RA). Previously, adrenocortical hormone, dehydroepiandrosterone (DHEA) was shown as a potential therapy for autoimmune disorders. However, data regarding effects of DHEA in RA are limited. The aim of this study was to investigate the effects of DHEA on quality of life (QOL) in premenopausal rheumatoid arthritis patients. In this randomized double blinded, controlled trial 46 premenopausal rheumatoid arthritis patients were assigned to receive 50mg/d DHEA (23 patients) or placebo (23 patients) for 12weeks. Disease Activity Score of 28 joints - erythrocyte sedimentation rate (DAS28-ESR) questionnaire, visual analog score and swollen and tender joint counts (both 0-28) were used for assessment of disease activity. Persian-validated World Health Organization Quality of Life Brief version (WHOQOL BREF) questionnaire was used to assess quality of life. In comparison to the control group more improvement in QOL (P=.025) and environment health (P=.001) was observed in the DHEA group. After adjustment for age and disease duration DHEA was associated with more improvement in QOL (P=.01), psychological (P=.02) and physical health (P=.03). A trend toward a decrease in ESR was observed in DHEA group (P=.06). DAS was improved in both groups; however, there was no significant change in DAS28 between groups (P=.88). Frequency of adverse events albeit minor was similar in both groups. Our study supports a slightly superior effect of DHEA over placebo to improve QOL in premenopausal female patients with rheumatoid arthritis. We did not find improvement in DAS in the DHEA group over placebo.

AB0204 A NEW INFLAMMATORY MARKER ASSOCIATED WITH DISEASE ACTIVITY IN PATIENTS WITH RHEUMATOID ARTHRITIS: PLATELET TO ALBUMIN RATIO

Background:Rheumatoid arthritis (RA) is an inflammatory autoimmune disease characterized by disordered immunity and dysregulated cytokine. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) have been defined as inflammatory markers to evaluate disease activity of RA. Recently, platelet to albumin ratio (PAR) was reported as a new prognostic index in patients with cancer. However, similar studies have not been displayed in RA.Objectives:This study was to explore the role of PAR in RA and its association with disease activity.Methods:This retrospective study enrolled 136 RA patients and 87 age- and gender-matched healthy controls. Neutrophil, lymphocyte, monocyte, platelet, hemoglobin, albumin, NLR, neutrophil to hemoglobin ratio (NHR), neutrophil to albumin ratio (NAR), monocyte to lymphocyte ratio (MLR), monocyte to hemoglobin ratio(MHR), monocyte to albumin ratio(MAR), PLR, platelet to hemoglobin ratio (PHR), PAR, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and Disease Activity Score of 28 joints - ESR (DAS28-ESR) were detected. Receiver operation characteristic (ROC) curve was used to discriminate RA patients from healthy individuals. Relationships between PAR and DAS28-ESR as well as other laboratory data were measured by the Spearman’s correlations analysis.Results:RA patients showed higher levels of NLR, NHR, NAR, MLR, MHR, MAR, PLR, PHR PAR and lower levels of albumin than healthy controls. PAR and other inflammatory parameters were also raised along with increased disease activity in RA patients (P &lt; 0.05) except NHR (P = 0.098). Similarly, albumin was decreased in RA patients as the disease activity increased (P = 0.001). ROC showed that area under curve (AUC) of PAR (0.887, 95%CI: 0.843-0.931) was higher than NLR (0.818, 95%CI: 0.762-0.874), NHR(0.839, 95%CI: 0.787-0.890), NAR(0.829, 95%CI: 0.776-0.882), MLR (0.794, 95%CI: 0.734-0.854), MHR(0.817, 95%CI: 0.760-0.874), MAR(0.814, 95%CI: 0.757-0.872), PLR (0.832, 95%CI: 0.779-0.886), PHR(0.884, 95%CI: 0.838-0.930) and albumin(0.860, 95%CI: 0.813-0.908). Besides, PAR was positively correlated with DAS28-ESR (r = 0.429, P &lt; 0.001), CRP (r = 0.540, P &lt; 0.001) and ESR (r = 0.492, P &lt; 0.001), yielding a highest relevance than other inflammatory indexes.Conclusion:This study demonstrated that PAR was elevated in RA patients and increased with the disease activity. PAR may be a novel marker to assess the disease activity of RA patients.

Factors associated with successful discontinuation of certolizumab pegol in early rheumatoid arthritis.

AimThe Certolizumab–Optimal Prevention of joint damage for Early Rheumatoid Arthritis (C‐OPERA) study demonstrated that in methotrexate (MTX)‐naïve early RA patients with poor prognostic factors, 1‐year certolizumab pegol (CZP) therapy added to the first year of 2‐year optimized MTX therapy brings radiographic and clinical benefits through 2 years even after stopping CZP. This exploratory analysis aimed to identify factors at baseline and at CZP discontinuation associated with successful CZP discontinuation.MethodsMTX‐naïve early RA patients with poor prognostic factors entered C‐OPERA (NCT01451203), a multicenter, randomized controlled trial. Patients were randomized to CZP + MTX (n = 159) or PBO + MTX (n = 157); those who completed the 1‐year, double‐blind period received MTX alone in Year 2 (CZP + MTX→MTX, n = 108; PBO + MTX→MTX, n = 71). Association between factors at baseline or at discontinuation of CZP and clinical/radiographic outcomes were evaluated by multiple logistic regression analysis. Predictive value cut‐offs were calculated using receiver operating characteristic analysis.ResultsSex (male) and low baseline Disease Activity Score of 28 joints – erythrocyte sedimentation rate (DAS28‐ESR) were associated with simple disease activity index (SDAI) remission (≤3.3), whereas high baseline DAS28‐ESR and modified total Sharp score (mTSS) were associated with clinically relevant radiographic progression (yearly progression mTSS > 3) at Week 104 (across both treatment arms). Low DAS28‐ESR (<2.1) and rheumatoid factor (RF; <74 IU/mL) at discontinuation of CZP were associated with SDAI remission at Week 104. At Week 104, SDAI remission was achieved by 75.0% (42/56) of patients with low DAS28‐ESR and RF at discontinuation, compared to 15.4% (2/13) of patients with high DAS28‐ESR and RF.ConclusionPatients with low RF and low disease activity after treatment with CZP + MTX may be able to discontinue CZP without risk of loss of response.

Evaluation of risk factors for atherosclerosis using carotid ultrasonography in Japanese patients with rheumatoid arthritis.

Previous studies have reported that patients with rheumatoid arthritis (RA) have a higher risk of developing cardiovascular disease (CVD) than the general population. A major cause of CVD is atherosclerosis, which can be evaluated with carotid ultrasonography (US). As far as we know, there have been no large-scale carotid artery US studies in Japanese patients with RA. The aim of this study was to identify the risk factors for atherosclerosis in Japanese patients with RA. The study subjects underwent physical examinations, laboratory tests and US examination, and answered a questionnaire about their lifestyle. Carotid US was performed to measure the maximum carotid intima media thickness (max cIMT) and to detect plaques. Atherosclerosis was detected in 238 patients (52%). Age, hypertension, and total/high-density lipoprotein cholesterol ratio were positively related to max cIMT. Presence of plaques was related to age, Disease Activity Score of 28 joints-erythrocyte sedimentation rate (DAS28-ESR), smoking, and any biological treatment. DAS28-ESR correlated positively not with cIMT but with the development of plaques in our patients with low disease activity (average DAS28-ESR of 2.7). Disease Activity Score of 28 joints-erythrocyte sedimentation rate was related to the size and number of plaques, whereas only traditional risk factors were related to max cIMT. This indicated that the inflammatory conditions of RA could affect the formation of atherosclerotic plaques. For the management of CVD in patients with RA, it may be important to control not only traditional risk factors, but also RA disease activity.

Elevated expression of interleukin-37 in patients with rheumatoid arthritis.

This study aims to discuss plasma and messenger RNA (mRNA) levels of interleukin (IL)-37 in rheumatoid arthritis (RA) patients and evaluate the potential of plasma IL-37 as a biomarker for RA. Plasma IL-37 levels and IL-37 mRNA relative concentrations were measured by enzyme-linked immunosorbent assay (ELISA) and quantitative reverse transcriptase-polymerase chain reaction (RT-PCR). We discussed the association of IL-37 levels and clinical, laboratory parameters in RA patients in a training cohort. Plasma IL-37 levels were tested for discriminatory capacity by receiver operating characteristic (ROC) curve analysis. We then validated plasma IL-37 expression in a cohort of 598 patients (230 RA, 107 systemic lupus erythematosus [SLE], 100 osteoarthritis [OA], 62 gout, 51 primary Sjögren's syndrome [pSS], 48 ankylosing spondylitis [AS]). Both plasma levels of IL-37 and mRNA levels of IL-37 were elevated in RA patients compared to those in healthy controls in the training cohort, and there was a good diagnostic ability to predict RA (area under the curve [AUC]=0.97). Plasma IL-37 levels were significantly related to Disease Activity Score of 28 joints - erythrocyte sedimentation rate (DAS28-ESR) (rs =0.459, P<0.001). The levels of IL-37 mRNA were related to plasma IL-37 levels (rs =0.642, P<0.001), DAS28-ESR (r=0.641, P<0.001) and C-reactive protein (rs =0.603, P<0.001). In the validation cohort, when plasma IL-37 in RA patients compared with that in SLE, OA, gout, pSS and AS patients, the AUC was 0.86, 0.87, 0.91, 0.87, 0.92, respectively. IL-37 expression was increased in RA patients, and correlated with disease activity. IL-37 may be a biomarker for the diagnosis of RA.

Real-world effectiveness and safety of rituximab in the treatment of rheumatoid arthritis: A single-center experience in Taiwan.

To assess the real-world effectiveness and safety of rituximab (RTX) at 24months in patients with established rheumatoid arthritis (RA) and to identify predictors of low disease activity/remission and a good European League Against Rheumatism (EULAR) response. Seventy RTX-treated RA patients were enrolled. Predictors for low disease activity/remission and a good EULAR response at 24months were identified by multivariate analyses. At 24months, the mean Disease Activity Score of 28 joints-erythrocyte sedimentation rate (DAS28-ESR) decreased from 6.88±0.85 at baseline to 3.47±0.85. Twenty-nine patients (41.4%) reached low disease activity/remission, while all patients had a moderate/good EULAR response. After adjustment by multivariate analyses, we found concomitant methotrexate at a dosage >10mg/week (odds ratio [OR] 5.17; 95% CI 1.34-19.93; P=0.017) predicted low disease activity/remission, and baseline DAS28 ≤6.5 (OR 4.97; 95% CI 1.22-20.30; P=0.026) predicted good EULAR response at 24months. The most common adverse events were infusion-related (5.7%), and there was no incidence of malignancy or mortality during the treatment. RTX was effective and safe in real-life management of RA patients with high disease activity. Patients taking concomitant methotrexate and with lower baseline DAS28-ESR were more likely to benefit from RTX.

Radiological patterns of pulmonary involvement may predict treatment response in rheumatoid arthritis: A retrospective study.

There have been no reports on the relationship between lung radiological patterns and rheumatoid arthritis (RA) disease activity or RA treatment response in patients with RA-associated lung disease (RA-LD). Patients with RA-LD who underwent treatment for RA from April 2005 to March 2015 were retrospectively evaluated. RA-LD patients were divided into three groups based on high-resolution computed tomography (HRCT) patterns [usual interstitial pneumonia (UIP), nonspecific interstitial pneumonia (NSIP), and bronchiolitis]. The disease activity score of 28 joints-erythrocyte sedimentation rate (DAS28-ESR) and the response of RA to treatment, as measured by the European League Against Rheumatism (EULAR) response criteria, were investigated. A total of 77 patients (21 with UIP, 23 with NSIP, and 33 with bronchiolitis) were enrolled. Median scores (interquartile range) on the DAS28-ESR at baseline were 5.27 (4.76-5.74), 5.48 (4.24-6.34), and 5.04 (3.90-5.66) for UIP, NSIP, and bronchiolitis, respectively; there were no statistical differences between the three groups (p = 0.412). One year after baseline, 19 (90%), 14 (61%), and 19 (58%) of patients in the UIP, NSIP, and bronchiolitis groups, respectively, were considered good or moderate responders, as evaluated using the EULAR response criteria; there was a significant difference between these three groups (p = 0.014). Multiple logistic regression analysis revealed that the UIP pattern was significantly associated with good or moderate response to RA treatment 1 year after baseline (p = 0.012). These results suggest that NSIP and bronchiolitis HRCT patterns may be risk factors for resistance to RA therapy.

Relationship between neutrophil-lymphocyte, platelet-lymphocyte ratio and disease activity in rheumatoid arthritis treated with rituximab.

Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) may be used as indicators of inflammatory markers and disease activity due to inflammatory changes in neutrophils, platelets and lymphocytes. Our aim is to investigate the relationship between NLR, PLR ratio and disease activity in RA patients treated with rituximab. Thirty-eight patients (8 male, 30 female, mean age 56.8±11.8years) diagnosed with RA and 30 healthy controls were included in the study. Disease Activity Score of 28 joints - erythrocyte sedimentation rate (DAS28-ESR), lymphocyte, neutrophil, platelet counts, ESR, C-reactive protein (CRP), PLR, and NLR were evaluated before and after rituximab in RA patients. The relationship between all parameters was assessed by Pearson's correlation, Wilcoxon signed-rank, Mann-Whitney U and paired t tests. The levels of CRP, ESR, and DAS28-ESR decreased significantly at 6months of rituximab treatment compared to pre-treatment. NLR and PLR ratios were higher in patients with RA than the control group. The median levels were 33.5mm/hour, 5.7mg/dL, and 3.7 respectively after 6months of rituximab treatment. And, the levels were lower than baseline treatment. There was a significant correlation between the levels of DAS28-ESR and NLR, DAS28-ESR and PLR before and after treatment. The NLR and PLR were higher than healthy controls and correlated with DAS28-ESR in patients with RA. These parameters which are indicative of disease activity decrease with rituximab and correlate with disease activity at 6months. The NLR and PLR may be useful indices to evaluate RA disease activity treated with rituximab.

Serum vitamin D level and disease activity in patients with recent onset rheumatoid arthritis

Rheumatoid Arthritis (RA) is one of the most prevalent autoimmune diseases. Due to the significance of the relationship between serum vitamin D levels and autoimmune diseases, this study aimed to determine the relationship between serum vitamin D level and the severity of disease activity in patients with newly diagnosed RA. This cross-sectional study was conducted on 66 patients meeting the American College of Rheumatology - European League Against Rheumatism classification criteria for RA. It was performed in 2012 using simple sampling. The disease activity was measured based on Disease Activity Score of 28 joints - erythrocyte sedimentation rate (DAS28-ESR) and serum 25-OH vitamin D (25(OH)D) levels using the chemiluminescent immunoassay method. In addition, the levels of ESR and C-reactive protein (CRP), the duration of morning stiffness, and the number of joints with tenderness and swollen were calculated as well. The data were analyzed using the Pearson correlation coefficient. In this study, 10 patients were male (15.2%) and 56 were female (84.8%). The average age of the participants was 45.2 ± 15.3years. The average level of 25(OH)D in the patients' serum was 30.5±28.9ng/mL and the mean DAS28-ESR was 5.6±1.1. The correlation coefficient showed that there was an inverse relationship between 25(OH)D and DAS28-ESR, the number of tender and swollen joints, global patient assessment and duration of morning stiffness (P<0.01). However, the average 25(OH)D level was not related to ESR (P=0.779) and CRP (P=0.269). The results of this analysis indicated that patients with more active RA have a lower serum vitamin D level.